Using comic books in med school: A creative way to teach

In medical school, there are few opportunities for students to stop, pause and reflect on where they’ve been, who they’ve become and where they are going. At Penn State College of Medicine, one physician professor is using comics to teach medical students how to creatively reflect on their experiences as they form their professional and personal identity.

For seven years, Michael Green, MD, an internist and bioethicist at Penn State where he is vice chair of the department of humanities and director of the program in bioethics, has taught a class called “Comics in Medicine.”

“The purpose of art is washing the dust of daily life off our souls,” Pablo Picasso said. And that’s what the “Comics in Medicine” course is all about, according to Dr. Green. When it comes to understanding an important experience, talking about it is good, writing about it may be better, but finding a creative way to express feelings visually can help the artist—or student—better grasp what the experience was all about.

“Medical school is an intense experience,” Dr. Green said. “It’s like running a marathon at sprint speed—you never slow down. During this course, [medical students] get to slow down, pause and try to make sense of who they are right now.” And, the juxtaposition of words and images in the comic format provides an effective medium for students to reflect on the formative experiences of medical school.

In an article published in Academic Medicine, Dr. Green describes five distinct themes that appear in students work: How I found my niche, the medical student as patient, reflections on a transformative experience, connecting with a patient and the triumphs and challenges of becoming a doctor.

“The medium of comics frees students up to express themselves metaphorically in ways they might not be inclined to do otherwise,” he said. “One troubling theme that comes up again and again is how students feel powerless and mistreated. And so they depict people who are supposed to be their role models and mentors in less than flattering ways.”

“There’s always a grain of truth in dark humor,” he said. “A lot of times students depict their attending physicians and mentors as monsters, using imagery from horror fiction and film. Though it’s over the top and exaggerated, the images nevertheless reveal how students perceive their place in the medical hierarchy.”

Are we in Gotham or med school?

Penn State College of Medicine is home to the first department of humanities at a U.S. medical school and has pioneered many innovative techniques for teaching humanities in the medical school setting.

“The humanities department plays a very prominent role in the curriculum at Penn State,” Dr. Green said, “and the comics course is but one example of innovations that are taking place throughout the curriculum.”

Comics in Medicine is a month-long course where students meet twice a week for two and a half hours. In a hybrid seminar-workshop style, students experience three types of activities.

Reading comics and graphic narratives about medical themes. “There are many book-length graphic narratives that have been published over the past decade that address medical themes such as experiences with illness, dealing with cancer and stories about the medical system,” Dr. Green said.

Drawing and brainstorming. Another aspect of the course is “engaging in creative activities where we practice drawing, creative writing or brainstorming ideas,” Dr. Green said.

Completing a comic narrative. “From the first day of class students are working on a final project, which is to tell their own story about a formative experience they’ve had during medical school in the format of a comic. This is a very labor intensive, time-consuming and challenging activity,” he said.

“We spend a lot of time workshopping, where they start out with the idea then write a draft and make sketches,” Dr. Green said. “They eventually turn it into a comic that we publish in booklets and post online.”

Med students and the adventures of clinical training

Often, the student who walks into the course is different from the student who walks out the door at the end, Dr. Green said. And every time he teaches the course, Dr. Green asks the students what they expect out of it.

“Initially, my expectation was that I’d get a lot of students who’d say they were lifelong fans of comics and love to draw,” he said. “But most students say they don’t read graphic novels and they can’t draw.”

“But they’re interested,” he said. “They say it sounds fun or they want to do something different and new. I ask them how relevant they think comics are to their medical education; and by the end of the class the numbers go up dramatically.”

“One of the reasons I teach using comics is that I think the process of carefully reading and creating comics involves skills that are relevant to being a doctor,” Dr. Green said.

“I’ve had students say, for example, after reading a graphic novel where there are images of how doctors are portrayed, they’ve never noticed how it makes somebody feel if you’re talking to them and your back is turned toward the computer,” he said. In one of the course materials, “the doctor is giving bad news about cancer and has a huge smile on her face and the family can’t understand why she’s smiling. The students say, ‘Wow, I do that, I smile when I get nervous and never knew that was so offensive.’”

Students practice the skill of paying close attention to detail by drawing their own comics. “You have to really concentrate and be an observer of the world around you if you want to accurately depict a scene where a doctor is interacting with a patient,” he said. “You have to think about their body position, the expression on their face and where the patient is situated in relation to the doctor.” And how students make these choices in their own work reveals a great deal about how they see themselves within the medical culture.

More and more, the humanities are part of the medical school curriculum. Another example art is medical school is Mark Stephens, MD, a family physician and professor at the Uniformed Services University in Maryland, who is using art to give students time for self-exploration. Through the making of masks, students explore the ultimate question: Who am I?